标题：Adolescent Participation in Preventive Health Behaviors, Physical Activity, and Nutrition: Differences Across Immigrant Generations for Asians and Latinos Compared With Whites
摘要：Objectives. We investigated preventive health behaviors (bicycle helmet, seat belt, and sunscreen use), physical activity, television viewing or video game playing, and nutrition (fruit, vegetable, milk, and soda consumption) among Asian and Latino adolescents living in the United States; assessed trends across generations (first-, second-, and third-generation immigrants or later); and compared each generation with White adolescents. Methods. We used data from 5801 adolescents aged 12 to 17 years in the representative 2001 California Health Interview Survey. Results. In multivariate analysis, first-generation Asians measured worse than Whites for preventive health behaviors (lower participation), physical activity (less activity), and television viewing or video game playing (more hours), but improved across generations. For these same behaviors, Latinos were similar to or worse than Whites, and generally showed no improvement across generations. First-generation Asians and Latinos had healthier diets than Whites (higher fruit and vegetable consumption, lower soda consumption). With succeeding generations, Asians’ fruit, vegetable, and soda consumption remained stable, but Latinos’ fruit and vegetable consumption decreased and their soda consumption increased, so that by the third generation Latinos’ nutrition was poorer than Whites’. Conclusions. For the health behaviors we examined, Asian adolescents’ health behaviors either improved with each generation or remained better than that of Whites. Latino adolescents demonstrated generally worse preventive health behaviors than did Whites and, in the case of nutrition, a worsening across generations. Targeted interventions may be needed to address behavioral disparities. In the year 2000, 1 in 5 children in the United States was an immigrant or a child of immigrants, 1 yet the health and health behaviors of this large and growing population remain understudied. 2 Research on immigrant adolescents suggests that rates of risk behaviors such as substance use increase across generations, 3 , 4 but other health-related behaviors have received less attention. Differences across racial/ethnic groups have been noted overall for prevalence of adolescent behaviors such as bicycle helmet and seat belt use, physical activity, and eating a healthy diet. 5 A large percentage of the Asian and Latino populations are first- or second-generation immigrants, 6 yet no studies have compared multiple generations of these groups with Whites to understand whether behavioral disparities may be emerging across generations. Acculturation is the multidimensional and multidirectional process whereby immigrants and their descendents adopt the behaviors, beliefs, and values of the host culture while adapting those belonging to their culture of origin. 7 , 8 Generation status does not directly measure acculturation, but is an important and easily identifiable measure representing length of exposure to the host culture. Generation status has been associated with variations in health care access and utilization, 9 education outcomes, 10 and health-risk behaviors. For Latino adolescents, substance use and sexual activity have been shown to increase with generation. 11 , 12 One small study that explored preventive health behaviors suggested that foreign-born Latino adolescents use seat belts more often than do US-born Latino adolescents. 13 For some Latinos, the language spoken at home and the proportion of foreign-born neighbors mediate obesity-related behaviors such as dietary behavior, physical activity, and smoking, and these differences are related to the increased obesity seen in US-born Latino adolescents. 14 For Asian youths, the association of behavioral trends with generation status remains largely unexplored, although one study that measured acculturation linked increased English language use to smoking. 15 However, Asian adults’ use of cigarettes and alcohol increases between first and second generation, 16 , 17 and their diet appears to worsen. 18 , 19 Asian adolescents’ preventive health behaviors may similarly decline in prevalence. The phenomenon of health and health behaviors worsening from first to later generations has been termed “the healthy immigrant effect.” 20 No study has explored whether this trend holds across ethnic groups for multiple health-related behaviors such as physical activity, preventive behaviors (bicycle helmet, seat belt, and sunscreen use), television viewing and video game playing (with less considered healthier), and dietary behaviors (higher fruit, vegetable, and milk consumption; lower soda consumption). Nor have studies compared multiple racial/ethnic groups with Whites to learn whether the worsening health (with increased time in the United States) suggested by the healthy immigrant effect also signals the emergence of disparities in behaviors. Whites’ behaviors are not meant to represent an ideal, but instead to serve as a basis for comparison. In 2002, California received more than one quarter of the nation’s immigrants—more than any other state—with Latinos making up the largest group, followed by Asians. 21 Therefore, we analyzed data from a representative study of California adolescents that included a large sample of Asians and Latinos. We examined the health-related behaviors of California adolescents in 4 ways. We assessed behaviors for Asians and Latinos and compared each group as a whole first with White adolescents and secondly with each other. Next, we compared each generation with Whites. Finally, we analyzed data for within-group racial/ethnic trends across first, second, and third or higher generations for Asians and Latinos. Characterizing the health-related behaviors of immigrant populations and how these behaviors change with generation may identify subpopulations among which clinical or public health interventions may be particularly effective.
